The

‘Bold Guide’

to

‘Setting up and running a

Low Vision Services Committee’

In England 2003

Introduction

It is now two years since the Implementation Project began, with the support of the DH and voluntary sector funding, to assist individual areas in the promotion of the Low Vision Services Report. By implication, this requires local areas to address issues of both service provision and quality by the creation of Low Vision Services Committees (LVSC’s).

While some areas already have similar groups, many areas have struggled with both the relevance of such a body and also the practicalities of setting-up and maintaining a Committee.

This document attempts to create a resource to support the process providing example documentation and information on how to work effectively through a committee structure.

In endorsing such a document, the National Low Vision Service Implementation Group (LVSIG) were keen to emphasise, that the document should be seen as providing general guidance. It should not detract from the overall idea that LVSC’s should address local issues by applying the standards as they relate to the nearby community.

The Early Stages

Setting up

Part One of a series of documents to support Low Vision Services Implementation.

Introducing Low Vision Services Implementation – getting everyone together

Who should do this?

There has been no hard and fast rule as to which person or organisation should take the initiative and organise a meeting to bring people together. Some points to bear in mind: -

  • Whoever organises the meeting should be familiar with the Low Vision Services Report and support the setting up of an LVSC as a ‘means to an end’ in securing services locally
  • It would be helpful if the organising body can offer practical resources in the form of meeting room and administration or at least be able to organise this if required
  • It helps if the organising agency has some recognised role in providing and/or advocating for low vision services. They should be able to identify the key local people/agencies to be invited
  • One person should be prepared to take a co-ordinating role, this may include using the services of the National Implementation Officer and liasing with other agencies before the meeting

Which groups might be interested?

Statutory agencies :Social Care

Different local authorities may organise services in various ways. However, the ADSS (Association of Directors of Social Services) publication entitled ‘Progress in sight’ – the National standards of social care for visually impaired adults* states that each social services department (or agency responsible for providing social care services) should have a senior manager responsible for developing and managing services for visually impaired people. [Standard 4 Managing Services: 4.1]. In addition, the ADSS standards also give guidance on the need to have a multi-agency group to co-ordinate services. [Standard 2 Planning Services: 2.2].

*ADSS (October 2002) Progress in sight - National standards of social care for visually impaired adults can be downloaded from: -

Where there is a team dedicated to sensory impairment/visual impairment, or dual sensory loss, it is possible that the senior manager or delegated staff member will assume some responsibility for the creation of such a group or LVSC. Otherwise, the manager on a disability team or adult services team may be a useful contact. It is also worth noting that in some areas other agencies such as voluntary sector organisations representing people who are visually impaired may, either through contracts or local practice, have assumed the statutory duty for providing these services.

An explanation of the term “social services” and the job roles of social workers and rehabilitation staff can be found in Appendix 1 entitled ‘Jobs’. These have been taken from and are available on the SCA website at

Statutory Agencies: Primary Care

Local Optical Committees

These Committees represent the interests of local opticians and help inform health bodies and other agencies on matters relating to eye care.

In the past, by law, they were required to be grouped into areas corresponding to those of the Health Authority. Now LOC’s will be recognised by PCT’s rather than the HA’s. This means that an LOC cannot represent a region smaller than a PCT area, but it can represent several PCT areas. How this is organised in each area will depend on local agreement about boundaries and responsibilities. The Association of Optometrists (AOP) keeps a list of all LOC’s and this is regularly updated. In addition there is advice about how boundaries might change its web-site: -

An example page of the most recent list (February 2003) is included at Appendix 2. The whole document will be on the CD.

A government organisation NatPaCT (National Primary and Care Trust) has recently published guidance to help Primary Care Trusts develop the work of optometrists. A whole section of this guidance relates to Low Vision Services and there is a strong commitment to the establishment of LVSC’s.

Web-site address: -

Optometric Advisors

Health authorities, PCT’s and other national and local health agencies may employ Optometric Advisors (OA’s) to give professional advice on issues relating to eye care. Most are employed on a part-time basis and undertake a variety of tasks concerned with the delivery of optometric services. In some areas Optometric Advisors have provided vital links with the commissioning Health Authority (HA) and have been the key to the setting up and development of an LVSC.

As of January 2003 there are, approximately, 44 advisors in the UK and the majority of these are employed by organisations that are members of the Optometric Advisers’ Group (OAG).

The Group provides a national networking forum for people advising on the delivery of optometric services within the NHS and maintains a list of contacts for member organisations. The Group can be contacted at: -

Statutory agencies: Primary Care Trust leads

When the Low Vision report was produced, it was envisaged that LVSC’s would also correspond to the then HA boundaries. This seemed to reflect the need to reduce fragmentation and introduce some local consistency. As HA’s are no longer formed in the same way, it will be for local groups to determine the most useful area to be covered by the LVSC. In many cases this will reflect the ‘old’ HA boundaries or county boundaries, although in some cases PCT areas may be appropriate. See Appendix 3 for a list of current LVSC’s and the areas they cover.

Where there are several PCT’s likely to be involved in a particular area, it may be useful to know that there is a ‘lead’ PCT or officer looking at a particular issue. For example, one PCT may be taking the lead on public health issues, older people, disability or eye care.

Lists of local PCT’s can be found on the NHS web-site: -

Voluntary Agencies: National Association of Local Societies for Visually Impaired People (NALSVI).

NALSVI promotes and supports local societies for blind and partially sighted people. It represents a network of 130 local societies in the UK and Northern Ireland. The organisation has produced a leaflet in conjunction with Age Concern about Low Vision Implementation. There is a representative on the National Low Vision Implementation Group and Sue Ferguson is the Administrative Officer and can be contacted for details about the local society.

Telephone: 01904 671921

What about existing disability/visual impairment interest groups?

Across the country there are several groups already in existence that look at disability issues or specific issues relating to people and visual impairment. Some of these groups will have already looked at many of the topics that might be addressed by an LVSC.

It is also likely that the group will have developed a committee structure and terms of service. Rather than set-up a new Committee, that will in all likelihood simply duplicate work, one suggestion is to have a sub-committee or special interest group that reports and develops low vision issues. Areas that have taken this approach are listed in Appendix 4 and also on the disc.

Who should be invited?

The Low Vision Report outlines the expected composition of the Committee. The size of the committee should be determined locally and its membership sought from: -

  • Hospital trusts
  • Primary Care Trusts (England)
  • Social Services/work teams responsible for sensory impairment
  • GP's
  • Voluntary Organisations for people with a visual impairment
  • Current Hospital and community-based providers of low vision services
  • Local Optical Committee
  • People with low vision including People from ethnic groups
  • Appropriate professionals (see footnote)
  • specialist sector workers in the fields of education, employment, care of older people, hearing impairment, learning difficulties and multiple disabilities.

Footnote: Appropriate professionals may include Dispensing Opticians, Occupational Therapists, Ophthalmic Nurses, Ophthalmologists, Optometrists, Orthoptists, Rehabilitation Officers/Workers and Social Workers. Those with experience of low vision service provision will be particularly important.

It is wise to invite as wide an audience as possible to the first ‘introductory meeting’. This serves several purposes: -

  • Highlights the issues for local health and social care providers
  • Enables people to meet before a Committee is created
  • Creates a ‘pool’ of interested agencies who may provide future input or be co-opted on to the group to address particular issues
  • Identifies service users and provides information in a less threatening manner

Tips

Never assume that health/social care commissioners are aware of the issues – they may need extra information to encourage them to attend. It may help to identify specific issues of current interest.

These may include: -

  • The care and rehabilitation needs of older people
  • Joint equipment
  • Joint assessment
  • Falls prevention
  • Attracting user views
  • Optometric competencies
  • Providing locally based services

Reports that may be helpful are listed in Appendix 4.

Do not forget that the service user has a very valuable role to play. However, people may not be familiar with the jargon and many of the recent developments in low vision. Ensure that service users are well briefed before the meeting and consider inviting a speaker to address a user group about the issues. It is worth reassuring service users about access issues, explaining that papers will be available in appropriate formats and advising about travel to and from the meeting.

The first ‘introductory’ meeting

Providing information before the meeting

Often it is useful to provide a paper or document about Low Vision implementation before the meeting. See example of first page at Appendix 5. The Implementation Officer will provide a paper ensuring that titles/area headings are specific to the local area. Remember, if you are sending out all copies in print to note that copies are available in other formats (Braille, large print, tape, disc etc). Service users should be contacted directly to ascertain their requirements.

The invitations

If additional information is not made available, the invitation will have to take this into account. Examples of invitations used around the country, have been included in Appendix 6. Where possible we have provided electronic versions on the disc attached to the front cover.

The role of the Implementation Officer

The Low Vision Consensus Group recognised the need to appoint an Officer to champion the cause and to support local committees. One of the roles is to assist in the setting up process and also to attend, at least, the initial meeting. In many cases it will be possible for her to attend further meetings – particularly where organisations feel that her input is useful.

At the initial meeting is it likely that she will use a short data-projection presentation, using Microsoft Power Point software – a standard version of this is included on the disc attached. This helps explain some of the history behind the Implementation process and discusses the role of a local LVSC.

Tips

  • Remember that the Officer may not be familiar with the local situation. If possible provide her with a brief resume of services and agencies
  • Make sure any ‘political’ issues are identified – i.e. it is useful for her to have a feel for how well people work together and whether any particular problems have already been identified
  • Identify the number of people attending that are service users and ensure that a handout is produced before hand in the appropriate format.

The rest of the (introductory) meeting

At this first introductory meeting it is unlikely that much business will be discussed. However, if time allows it may be possible for small groups to be convened to discuss low vision services issues.

Although this practice is common, it is useful to be reminded of the following:

  • Ensure that even the smallest groups have a ‘chair’ to lead discussions and who has been briefed about the discussion topics.
  • Check that group members have introduced themselves to help orientate service users and ensure that any hearing requirements are attended to (this may entail setting up a separate room with a loop system or using portable amplifiers)
  • Decide on a method of feedback – if flip-chart papers are used make sure that any ‘scribes’ make written print as accessible as possible. Ensure that contents are read out and that copies are made available to users after the meeting.

Groups may take different topics or concentrate on the same issues. Good points for discussion might be: -

  • Current Low Vision Services
  • The gaps in services
  • The role of a local LVSC
  • LVSC membership
  • Special populations – young people, learning disabilities, minority ethnic groups
  • The role of statutory and voluntary organisations
  • Emotional support

It is important that the points made during this exercise are noted ready for the first meeting. Often they help provide the agenda/action points for future work.

Another approach is to invite local providers and service users to explain about the current state of services. This could be done by asking for a short presentation (approx. 10 –15 minutes).

This can be a very useful exercise but needs to be treated with care. In particular, people need to feel that they can present details of their service, including deficiencies, without receiving personal or organisational criticism. It may help to brief speakers about the aims of this approach and suggest that they should use the opportunity to explain how they would run the service in an ideal situation.

It may be useful to help speakers maintain a consistent structure to their talk by suggesting details that could be discussed. These might include: -

  • An outline of how the service works
  • Special interests (children, adults with LD, minority ethnic groups
  • How people access their service
  • Where referrals come from
  • How many people are seen
  • The Low Vision professional/team
  • What are the links with other teams
  • User group/focus group work
  • Waiting times
  • Funding limitations
  • Numbers of people seen per year
  • Audits carried out
  • Hopes for the future

Should we have a Group?

At some point in the meeting it will be helpful to ask for the meeting to make a decision about whether to form an LVSC.

If there is a positive response then this might be the time to deal with some of the practical details.

Seeking nominations

Generally it is possible to discuss the Committee membership during this meeting. Clearly it is important that a record is kept of intended members and contact details (including where possible e-mail).

An alternative solution is to take written details (again ensuring a scribe is available to record service user details if required). In this case someone, perhaps from the organising body, needs to be responsible for confirming the final membership. It is important to ensure that as far as possible all recommended agencies are represented. It is particularly important to have Primary Care Trust and Social Services Commissioning representation as well as provider representation.

If there are particular gaps in membership, it is worth asking the Implementation Officer for assistance. Often the national LVSIG can assist in recommending local contacts. In addition she is able to make contact and can often provide a convincing argument in favour of involvement.

Agreeing the chair

Sometimes it is possible to agree who should chair the first session at this meeting. This has the advantage of ensuring that the first meeting runs smoothly (i.e. there is a clear direction and leadership) and that people are clear to whom to address issues.

However, it is very possible that many attendees will be meeting people for the first time and so would prefer to elect a chair at a later meeting. If this is the case, it is important that someone agrees to undertake this role on a temporary basis.

Agreeing other practical matters

One of the most important issues, but often the hardest to organise, is the job of recording the work of the meeting – the minutes. Where possible the minutes should be taken by someone who is not expecting to take an active part in the meeting. It would be desirable to use secretarial staff from health, social care or the voluntary sector.

Tips

  • There may be local grants available that would cover secretarial support and other administration costs
  • Local statutory bodies may be able to use their own secretarial staff – for example LOC’s and Optometric Advisor’s may have staff available

Setting the next date – checking access and timing

When setting the date, time and place of the first meeting it is important to bear the following in mind. Often the venue can be provided by voluntary or statutory agencies, however, there are some points that need to be considered:

  • Is the venue accessible for service users?
  • If service users require transport to the venue who will meet the costs and organise this?
  • Is the time convenient for both professionals and users?
  • Does the time exclude particular people – for example, parents, service users.

Appendix 7 shows a break down of the times chosen for meetings (as of November 2002).